Module 5

Principles of
Anesthesia Consideration in Anesthetic management
1. Physical status of the animal
2. Breed and temperament
Objectives:
3. Type and expected duration of the
1. Students will be able to recognize the surgery
principles of anesthesia 4. Skill of the anesthetist
2. The students will be able to apply the
5. Equipment and assistance available
physical restrain need to control the
surgical animal Pre-Anesthetic Examination
3. Students will be able to identify and
• Anesthesia is more of a threat to an
use the common veterinary
anesthetic drugs. animal’s well-being than the
4. Students will be able to recognize the contemplated surgery
stages of anesthesia • Degree of anesthetic risk depends on
5. The students will be able to apply the the physical status of the animal, the
use acupuncture to produce experience and capability of the
analgesia. anesthetist, and available equipment.
History: special attention should be given to
a history of the ff:
Anesthesia
• Nasal discharge, coughing, choking
• Insensibility or gagging
• Produced by a controlled, reversible • Dyspnea following exertion or
depression of the CNS. during rest
• Induced to avoid pain, provide • Reluctance to exercise
restraint, control convulsions, and in • Abnormal behavior such as
over dosage, euthanasia. prolonged sitting
• Abnormal intake or loss of food and
Four recognizable aspects of anesthesia water
• Previous diseases
1. Narcosis/unconsciousness • Recent administration of drugs
2. Sensory block
3. Motor block Inspection
4. Reduction of reflex activity • Alteration of haircoat, body shape, or
condition
• Obesity and dehydration
• Dyspnea

1
 • Mucous membrane for evidence of
cynosis, anemia, jaundice or
prolonged capillary time
Palpation
• Palpation of the larynx and trachea
will stimulate coughing if they are • Hypercapnia reduces cardiovascular
inflamed stability by directly depressing the
• Thrills may be palpated over the chest myocardium, increasing vagal
area responsiveness, and in most instances,
• Abdominal palpation to detect reducing peripheral resistance.
hepatic or splenic enlargement, • General anesthesia lessens the
presence of excess fluid or gas, and efficiency of gas exchange in the lung,
abnormalities of the urinary system. even when alveolar ventilation is
adequate
Auscultation • General anesthesia predisposes to
• Lung sounds obstruction of air passages through
• Heart rate and rhythm relaxation of associated muscles; this
is especially important in
Diagnostic aids
brachycephalic dogs
• Hematocrit • The trachea should be intubated in all
• Urinalysis anesthetized dogs
• Blood urea nitrogen: indicated in Circulation
dogs over 5 years old
• Liver function tests • General anesthetics compromise the
• Radiographs function of the cardiovascular system
to varying degrees, causing
• ECG, blood gas analysis, acid-base
diminution of reflex responsiveness
determinations provide useful
and “reverse
information in selected cases
• Drugs exert their effects on medullary
General Considerations centers and affect myocardial
Respiration contractility, venous capacity and
peripheral resistance
• The process whereby oxygen is
• General anesthesia commonly
supplied to and utilized by body cells,
decreased cardiac output by 25 to
and the carbon dioxide that is
40% as a result of reduced myocardial
produced is eliminated
contractility and stroke volume
• Nearly all anesthetics and narcotics
• Baroreceptor reflex responses are
depress spontaneous alveolar
depressed by deep anesthesia, and
ventilation at surgical levels of
severe by hypotension may follow
anesthesia and result in hypercapnia
sudden hemorrhage or elevation of
the cranial end of the animal

2
Ways to minimize the cardiovascular effects
if anesthesia:
1. Using the lightest level of anesthesia
compatible for surgery
2. Ensuring that hemoglobin level are
normal and hypovolemia does not • lessen bradycardia from increased
occur vagal tone associated with
3. Using high concentrations of inspired administration of potent narcotic
oxygen analgesics, methoxyflurane and
Pre-anesthetic Medication halothane
Indications Narcotics
1. Allay apprehension and aid in • Meperidine, morphine sulfate
restraint • Capable of producing analgesia,
2. Ease induction of anesthesia and sedation, or excitement depending on
recovery the method of administration and
3. Act as pharmacologic adjuncts to the dosage
general anesthetics • Provide analgesia through depression
4. Counteract the side effects and reflex of the sensory area of the cerebral
responses evoked by some anesthetic cortex
agents • Depress respiration, coughing and
General Considerations: blood pressure
• Morphine provides more sedation
• old and very young patients should than meperidine
receive minimum dose • Morphine induces vomiting,
• vicious and excitable animal should defecation and salivation
receive massive dose • Morphine and meperidine make
Anticholinergics animals more tractable and reduce the
amount of general anesthetic needed,
• atrophine sulfate, scopolamine
prevent excitement during recovery
hydrobromide, glycopyrrolate
and reduce pain post-operatively
• inhibits salivation and production of
• IV administration of narcotics should
mucous in air passages
be avoided
• effectively block bradycardia and
hypotension following laryngeal Tranquilizers
stimulation in the dog • Xylazine, acepromazine, ketamine,
• provide some protection against droperidol, azaperone
vago-vagal reflexes associated with • Abolish conditioned reflexes and
traction or pressure on viscera increase the threshold of response to
environment stimuli
• Do not induce analgesia, sleep or
anesthesia

3
 • Effective doses often cause ataxia
• Phenothiazine derivatives are the
only tranquilizers with wide clinical
acceptance
• Peripheral effects are hypotensive,
hypothermic, antihistaminic,
Mechanism of Action:
antiadrenalitic, antiemetic, and
antipyretic 1. Local anesthetic decreases rate and
• Tranquilized patients can be handled degree of depolarization by elevating
and anesthetized more easily, and the threshold value and decreasing
recover with less excitement membrane permeability to sodium
• Intramuscular route is preferable 2. Exact site of local anesthetics may be
than IV PO routes in the ff:
• External surface of the Na
Anesthetic Agents and Techniques channel
• Local anesthetics • The internal surface of the Na
• General anesthetics channel
o Inhalation anesthetic • The axoplasmic side of the Na
o Injectable anesthetic channel and within the cell
membrane
Local Anesthetics
• Within the cell membrane, where
• Interfere with nerve impulse the anesthetic produces lateral
conduction and render an area or pressure and constriction of the
region of the body insensitive to Na channels
painful stimuli
Indications
• Do not induce unconsciousness
• If the operative field can be
Mode of Administration
completely anesthetized
1. Topical • If the technic and limitations are
2. By injection known
• Into the tissues that are to be • If the animal’s conditions precludes
sensitized the use of general anesthetics
• Around nerves to desensitize the
Contraindications
tissues they innervate
• Into epidural or subarachnoid • Allergy to the local anesthetic agent
space to space to desensitize a • Area to be infiltrated is infected,
large region of the body fibrosed or deficient in circulation
bilaterally
Pharmacokinetics:
• Into joint spaces
1. Absorption and speed of onset
• Lipid solubility is directly
proportional to potency and duration
of action

4
 2. Distribution
• Protein binding correlates with the
duration of action. The timing site for
the local anesthetic within the Na
Channel is thought to be protein
• Epinephrine is added to some local
3. Methemoglobinemia may occur
anesthetics to prolong the duration of
following use of prilocaine or
action
benzocaine in cats and rabbits
Therapeutic Uses:
Epidural Anesthesia
1. Anesthesia
Horse
• Topical anesthesia: local
anesthetic are used to desensitize a. Low epidural: between 1st and 2nd Cy
the mucous membrane of the eye, vertebrae or between 1st Cy and last
nose and larynx sacral vertebrae; 10-12 ml solution
• Infiltrative anesthesia: local b. High epidural: lumbosacral foramen;
anesthetics are used to numb 100-150ml solution
tissue in a limited area Calves: use lumbosacral foramen; 3-8 ml
• Spinal anesthesia: epidural dose
injection of a local anesthetic
Dog:
anesthetizes the spinal cord or
cauda equina a. High epidural: lumbosacral foramen;
• Neurolytic anesthesia: ethyl give 2-10ml dose; no risk of subdural
alcohol, which is neurolytic has hit because the dura end at the 6th and
been used to produce prolonged 7th lumbar vertebrae
nerve blockade in animals. b. Low epidural: between the 1st Cy and
2. Control of arrhythmias sacrum or between the 1st and 2nd Cy
• Lidocaine infused or injected IV vertebra; do not exceed 1ml
is used to control premature Inhalation Anesthetics
ventricular contractions
1. The primary site of action of these
3. Facilitation of general anesthesia:
agents is the brain and the spinal cord
• IV injections of lidocaine are used
2. Analgesia and unconsciousness are
to decrease the dose of
produced when the concentration of
thiobarbiturate needed to induce
the anesthetic reaches a specific level
anesthesia.
in the CNS
Adverse Effects
Pharmacokinetics:
1. CNS: Skeletal muscle twitches are the
1. Establishment of an anesthetic partial
first sign of toxicity
pressure within the alveoli through
2. Cardiovascular System: Hypotension
ventilation of the lungs.
and decreased myocardial strength
2. Diffusion of the drugs into the blood
may occur
3. Circulation of the drug

5
Terminologies:
1. Minimum Alveolar Concentration
(MAC)
• The alveolar concentration that
prevents gross purposeful
movement in 50% of the patients 2. Blood: Gas partition coefficient
in response to standardized • Expression of the solubility of an
painful stimulus agent
• Used as a measure of potency • Solubility of the agent in blood
correlates with the speed of
induction and recovery
Preparations:
1. Nitrous oxide:
• May cause diffusion hypoxia
• Can cross the placenta
Correlation of MAC values and Doses:
• Seldom used in adult horse and cattle
• The anesthetic dose required to because it may increase the incidence
anesthetize 95% of animals is and severity of hypoxemia
approximately 1.2 to 1.4 times the 2. Halothane
MAC • Sold in brown bottle to prevent
• Surgical anesthesia level are achieved exposure to light and contains thymol
by obtaining alveolar concentrations as preservatives
equal to 1.4 to 1.8 times the MAC • Crosses the placenta
• If two anesthetics are administered • Triggers malignant hyperthermia in
simultaneously, the MAC multiples pigs
are additive 3. Methoxyflurane
Factors affecting MAC Values: • Has a distinctive “fruity” odor
• Can cross the placenta
1. Hypothermia, severe hypotension,
• Has a slow induction and recovery
advanced age, pregnancy, severe
times
hypoxemia, severe anemia or the
4. Isoflurane
concurrent administration of certain
drugs (tranquilizers) may decrease • The newest inhalant anesthetic
the MAC values cleared for veterinary use
2. Hyperthermia or hypothyroidism • The current agent of choice for
may increase the MAC value for a animals with suspected increases in
particular patient the intracranial pressure
3. The duration of anesthesia, patient 5. Sevoflurane
gender, acid-base balance, and • Halogenated inhalation anesthetic for
hypertension have no effect on the induction and maintenance of general
MAC value anesthesia

6
 • Volatile anesthetic that provides
hypnosis, amnesia, analgesia,
akinesia and autonomic blockade.
Injectable Anesthetics
Preparations:
3. Long acting (6-12 hours)
1. Barbiturates and barbituric acid • Phenobarbital
derivatives
2. Cyclohexylamines Notes:
3. Propofol • Thiopental and thiamylal are one of
4. Etomidate the drugs of choice for induction of
Barbiturates and barbituric acid derivatives anesthesia in animals with suspected
increased in intracranial pressure
Mechanism of action:
• Use of thiobarbiturates in
1. Bind to GABA receptors, decreasing greyhounds and other sight hounds is
the rate of dissociation of the not recommended
inhibitory neurotransmitter from the • Pentobarbital is the primarily as an
receptors anticonvulsant at subanesthetic doses
2. Decrease the excitatory effects of the
Cyclohexylamines
neurotransmitter glutamate
3. Alter synaptic transmission by Pharmacologic effects:
inhibiting Na and Ca channels and
• Causes dissociative anesthesia
potentiating K channels
• Palpebral, laryngeal, and pharyngeal
Effects: reflexes are maintained
• CV effect; transient hypotension and • Skeletal muscles of the eyelid are
increase in heart rate contracted
• Respiratory Effect: transient apnea • Somatic analgesia is good but visceral
• CNS: decrease cerebral blood flow, analgesia is poor
cerebral blood volume, and • Muscle relaxation is poor
intracranial pressure • Increases intracranial pressure
• Pregnancy: crosses the placental Preparations:
barrier
1. Phencyclidine
• Analgesic effects: not analgesic in
2. Ketamine
subanesthetic doses
3. Telazol (Zoletil)
Preparations:
Mechanism of action
1. Ultra-short acting (10-30 min)
• Inhibits the polysynaptic actions of
• Thiopental and thiamylal
the excitatory neurotransmitter Ach
• Methohexital and glutamate in the spinal cord and
2. Short acting (30-60 min) N-Methyl D-Aspartate in the brain
• Pentobarbital

7
Administration
• Can be administered IM or IV in cats,
dogs, small ruminants, and swine
• In adult horses and cattle, it is only
administered IV
Ketamine Combinations:
• Xylazine, guaifenesin, or both are
frequently administered to horses
prior to administration of ketamine
• Diazepam, midazolam, or xylazine
are frequently used with ketamine in
dogs and cats
• Guaifenesin, diazepam or xylazine
may be used in combination with
ketamine in pigs, cattle, sheep and
goats
Monitoring During Anesthesia Components of an Anesthetic Machine

Considerations: Gas supply: may be from large cylinders

1. Anesthetic depth stored remote from the anesthetic machine
2. Respiratory status or small volume cylinders attached directly
3. Cardiovascular status to the anesthetic machine
Pressure/Contents Gauge: indicates the
The Anesthetic Record pressure of gas in the cylinder when the
valve is open.
• Includes information relating to the
Pressure regulators: reduce pressures in
patient, the anesthetic drugs
gas cylinder to provide a constant flow of
administered, and intra-operative gas to the flowmeters; protects the delicate
monitoring flowmeters and allows the rate of gas
• Importance: administration to be regulated more finely
1. A visual record of CV and respiratory Flowmeters: indicate and control precisely
variables allows changes to be the rate of gas to the common gas outlet; an
identified more easily and quickly indicator rises in the tube as the flow rate
2. An archive resource is particularly increases.
useful if an animal is re-anesthetized; Vaporizers: vaporize a liquid anesthetic
the records provide accurate agent and add a controlled amount of vapor
to the gases delivered to the patient.
epidemiological data for the clinic
Common gas outlet: connects the
3. A legal document recording the anesthesia machine to breathing system
standard care connectors, ventilators, or oxygen supply
devices.
Oxygen flush: activates oxygen flow to the
common gas outlet bypassing the vaporizer
and flowmeter; can be used to deliver

8
oxygen in an emergency situation or flush
inhalant from breathing systems before the
patient is disconnected from the circuit.
Low oxygen warning devices: useful
safety mechanism; falling oxygen supplies
curtail the delivery of nitrous oxide and
2. Circle system:
simultaneously sound an alarms. Components:
• Rebreathing bag; provides the
Anesthetic Circuits animal’s respiratory minute volume
• Connect the anesthetic machine to • Canister with alkaline earth; absorbs
the endotracheal tube or face mask carbon dioxide
• Deliver inhalant anesthetics • “Y” piece valves: for unidirectional
• Supply oxygen gas flow; creates resistance for a
• Provide a mechanism for controlled one-way direction of gas flow
ventilation • Breathing tubes
• Inlet for fresh gas
• Pop off valve: allow escape of
Classification:
excess gas
1. Non-rebreathing circuits
• Provided with valves which allow Anesthetic Compilations and
inspiration from a breathing bag and Emergencies
exhalation directly into the
atmosphere Intraoperative Anesthetic Complications
2. Rebreathing circuits
• All or part of the exhaled gas is Hypoxemia
passed back into the system • Reduced arterial oxygen
• Circle system, to-and-fro systems concentration
• Best diagnosed using arterial blood
Advantages of Rebreathing circuits gas analysis
1. Low fresh gas flow rates • Common in patients maintained on
2. Low volatile agent consumption rate inhalant agents positioned in dorsal
3. Expired moisture and heat recumbency
conserved Causes
4. Less atmosphere pollution
• Low inspired oxygen concentration
due to anesthetic equipment failure
Disadvantages of Rebreathing Circuits
• Hypoventilation due to respiratory
1. Care with nitrous oxide
depression caused by anesthetic
2. Slow rate of change of anesthetic
agents
concentration in the circuit
3. Soda lime must be changed • Ventilation perfusion mismatch
regularly • Lung atelectasis
4. Expensive Treatment
• Ensure that the inspired oxygen
Types of Rebreathing System concentration is 100%
1. To-and-fro system: gases pass • Check that there is no respiratory
back and forth through the carbon obstruction
dioxide absorber twice instead of in • Minimize respiratory depression
a circular pattern; no valves needed; caused by anesthetic agents
the patient may inhale alkaline dust • Assist or control ventilation with
intermittent positive pressure
ventilation

9
 • Maximize cardiac output with fluid
therapy and administration of
positive inotropes

Hypercapnia
• Increased arterial carbon dioxide
concentration Cardiac Arrhythmias
• Best diagnosis using arterial blood • Detection with manual monitoring of
gas analysis the pulse and auscultation of the
• Results from respiratory depression heart
caused by anesthetic agents • Diagnosis of the type of arrhythmias
• Stimulates the sympathetic nervous by electrocardiography
system and cardiac arrythmias can
occur when it is severe Peri-operative Complication
Treatment
• Minimize respiratory depression Hypoxemia
• Assist or control Ventilation with • Most patient become hypoxemic
intermittent positive pressure when they start to breathe room air
ventilation • May be reduced by insufflation of
oxygen via a nasopharyngeal tube
Hypotension
• Low blood pressure diagnosed by Respiratory Obstruction
intraoperative monitoring techniques • Contributes to hypoxemia by
Causes of intraoperative hypotension increasing airway resistance,
• Myocardial depression caused by causing hypoventilation
anesthetic agents, particularly • Inspiratory efforts against a partially
inhalant gas
obstructed upper airway may
• Hypovolemia
produce pulmonary edema
• Acid-base and electrolyte disorders
Causes
resulting in depression of the
myocardium • Nasal cavity enlargement
• Cardiac arrythmias • Laryngeal dysfunction or paralysis
• Pre-existing disease, such as shock • Displacement of the soft palate
Treatment of intraoperative hypotension
• Minimize cardiovascular depression Pulmonary edema
caused by anesthetic agents • Relatively rare
• Support the cardiovascular system • Treatment consists of oxygen
with fluid therapy; consider therapy, diuresis, and administration
hypotonic saline
of NSAID’s
• Administer positive inotropes
(dobutamine, dopamine)
Musculoskeletal system injury
Inadequate anesthesia • Commonly seen in large animals
• May result in movement of the • Limb fractures and other injuries can
patient occur during surgery
• Occurs when there is a sudden
increase in surgical stimulation Post-anesthetic myopathy
• Managed with immediate • resulted from inadequate perfusion
administration of an intravenous of muscle tissue, producing ischemic
agent concurrent with a reduction in muscle damage
surgical stimulation.

10
11
12
Source: The Veterinary Medicine

13
Principles of Acupuncture
Introduction:
Understanding acupuncture in
today’s terms must take into account the
history of acupuncture and the changes in
the technology that developed as 1. Type I (motor) points are the most
acupuncture theory evolved. As such, to common and exist where nerves
know acupuncture is to know the nervous penetrate muscles.
system. Certainly, we know that for 2. Type II points are located where
acupuncture to work, it requires an intact nerves intersect on the dorsal and
nervous system, and acupuncture is not ventral midlines of the body.
effective if the nervous system is damaged 3. Type III points are located where
beyond repair. superficial nerves branch.
4. Type IV points are located where
From modern perspective,
nerves penetrate tendons (golgi
acupuncture represents a form of nerve
tendon organ)
stimulation. Local counterirritation caused by
needle insertion (or other form of Most acupuncture points are located at
acupuncture point stimulation) leads to areas low electrical resistance and high
microtrauma of the tissues. What follows is a electrical conductance of the skin. Deep in
complex, yet integrated series of reactions the point, there are accumulation of free
that leads to stimulation of the nervous nerve endings; small arterioles, veins,
system. Depending upon the acupuncture lymphatics; tissue mast cells. Stimulation of
point selected and the method of stimulation, these points results in degranulation of the
there will be sequential and simultaneous mast cells, activation of the inflammatory
activation of local, segmental, and super- cascade, alterations of blood and lymph flow,
segmental neural pathways. These changes and conduction of nerve impulses to the
ultimately lead to altered blood flow, altered central nervous system. This results in a
humeral responses, and effects within the local response that spreads over time
immune system. throughout the entire neural axis evoking
numerous biochemical changes within the
In animal, it is much easier to place a
nervous system and eventually the whole
needle directly through the haired skin to
body. The initial sensation is termed “de Qi”
achieve transcutaneous nerve stimulation
MEANING “the arrival of Qi.” In this context,
than to apply external electrodes to
Qi can be interpreted as energy.
accomplish the same effects.
The Qi consist of all essential life
Successful application of
activities, which include the spiritual,
acupuncture depends upon three important
emotional, mental and physical aspects of
factors: the acupuncture point, the method of
life. A person’s and animal health is
stimulation, and the response observed.
influenced by the flow of Qi in the body, in
Modern experiments have shown that
combination with the universal forces of Yin
acupuncture points occur where nerves
and Yang. Qi travels throughout the body
penetrate tissue planes or where nerves
along “meridians” or special pathways. The
themselves. As such, there are four major
meridians. Or channels are the same on both
types of acupuncture points.
side of the body (paired). There are 14 main
meridians running vertically up and down the
surface of the body. Out of these, there are

14
12 organ meridians in each half of the body. higher frequencies (200 Hz), the segmental
There are also 2 unpaired midline meridians. effects are influenced greatly by descending
The acupuncture points are specific serotonergic neurons, which can be blocked
locations where the meridians come to the by serotonin antagonists. This differential
surface of the skin, and easily accessible by control of segmental analgesia depending
acupuncture, moxibustion, and acupressure. upon the stimulus frequency partially
The connections between them ensure that explains the different results reported by
there is an even circulation of Qi, a balance some investigators in dealing with segmental
between Yin and Yang. Energy constantly pain control.
flows up and down these pathways.

Acupoints
Segmental and Super-segmental
Acupoints may be classified based on the
Responses to Acupuncture
acupuncture techniques, meridians, size and
Once the local acupuncture point is actions.
stimulated, nerve impulses will travel up the
Technique
sensory nerves to enter the spinal cord. For
the most part, the fibers are part of the pain There are generally two kinds of acupuncture
pathways, although proprioceptive fibers points that would require different kinds of
also are part of the overall activation by stimulation techniques.
acupuncture stimulation. The concept that Conventional Acupoints. The majority of
the acupuncture points are connected by acupoints belongs to this category. These
some sort of channel is part of TCM theory. points are used for dry needling,
These became kwon as meridians when the aquapuncture, electroacupuncture, and
acupuncture maps of the body were made by moxibustion. For example, ST-36 can be
French physicians. These does seem to be a used for the treatment of general weakness
close correlation between meridians and with dry needling, aquapuncture, or
nerve pathways, particularly those in the moxibustion.
extremities. Many of the properties ascribed
to meridians are present in the peripheral Hemoacupuncture. These points are on
nerves. superficial blood vessels and are stimulated
by using the hemoacupuncture technique.
The segmental analgesia from This is beneficial for acute excess heat
acupuncture utilizes several neurochemical pattern and Qi-blood stagnation pattern, but
systems depending upon the stimulus the hemoacupuncture technique is
applied. With electrical acupuncture at contraindicated for Qi and blood deficiency
frequency (4-20 Hz), the predominant patterns.
reaction is due to activation of dynorphin
neurons. This frequency also results in the Meridians. Acupoints may also be classified
release of endorphins from the brain stem by their association within certain meridians.
into the circulation as a super-segmental Regular points. Regular points are located
reaction. Both these compounds and their on the 14 regular channels (LU, LI, ST, HT,SI,
effects can be blocked by `naloxone BL, KID, PC, TH, GB, LV, CV and GV)and
(morphine antagonist). At frequencies typically identified by the alphanumeric
around 100 Hz, the primary mediator of numbering system (e.g., LU-11, SI-9, and
segmental analgesia is due to enkephalin, GV-14). In total, there are 361 known
which is not blocked by naloxone. At even acupoints on these channels.

15
LU- Lung channel (11 channels)
LI- Large intestine channel (21 channels)
ST-Stomach channel (45 channels)
SP-Spleen channel (21 channels)
HT-Heart channel (9 channels) • Fundamental Techniques in
Veterinary Surgery (1981) by D.
SI-Small Intestine channel (19 channels) Knetch et al.
BL-Bladder channel (67 channels)
• H.Xie and V. Preast. 2007.
KID-Kidney channel (27 channels)
Xie’s Veterinary Acupuncture.
PC-Pericardial channel (9 channels) Blackwell Publishing.
Th-Triple Heater channel (23 channels)
GB-Gall Bladder channel (44 channels)
LIV-Liver Channel (14 channels)
GV-Governing Vessel channel (26
channels)
CV-Conception Vessel channel (24
channels)

References:
• P.T. Colahan, A.M. Merritt,
J.N. Moore; Equine Medicine
and Surgery, Vol. I & II 5th Ed.
Copyright 1999; Mosby Inc. 1
1830 Westline Industrial, St.
Lois Missouri 63146

• Jorge A. Auer, John A.

Stick; Equine Surgery, 2nd
Edition Copyright 1992 W.B.
Sanders Co. Curtis Center
Independence Square West,
Philadelphia, Pennsylvania

• Textbook of Small Animal Surgery

(1985) by DH Slatter

• Small Animal Surgery. An

Atlas of Operative Techniques
(1979) by WE Wingfield and
CA Rawlings

16